Bibliographic Source(s)
| Hawley C, Elder G. Calcium. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Oct. 7 p. [14 references] |
| Hawley C. Calcium. Nephrology 2006 Apr;11(S1):S198-200. |
Guideline Status
This is the current release of the guideline.
UMLS Concepts ( what's this?)
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Disease/Condition(s)
- Chronic kidney disease
- Hypercalcemia
- Hyperparathyroidism
Guideline Category
Management
Treatment
Clinical Specialty
Endocrinology
Family Practice
Internal Medicine
Nephrology
Pediatrics
Intended Users
Physicians
Guideline Objective(s)
To explore whether there is an association between serum calcium and all-cause mortality and cardiovascular mortality, in particular while giving consideration to the well-established link between hypocalcaemia and worsening hyperparathyroidism
Target Population
Adults and children with chronic kidney disease
Interventions and Practices Considered
Maintenance of serum calcium level within the normal range (considered but not recommended)
Major Outcomes Considered
- Cardiovascular mortality
- All-cause mortality
- Metabolic bone disease
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Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
Databases searched: MeSH terms and text words for kidney dialysis were combined with MeSH terms and text words for serum calcium. This search was carried out in Medline (1966 to April Week 3, 2005). The Cochrane Renal Group Trials Register was also searched for calcium trials not indexed in Medline.
Date of searches: 3 March 2004. A further Medline search was carried out for the period 1 Feb 2004 to 30 Apr 2005.
Number of Source Documents
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test
Methods Used to Analyze the Evidence
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Rating Scheme for the Strength of the Recommendations
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Comparison with Guidelines from Other Groups
Peer Review
Description of Method of Guideline Validation
Recommendations of Others. Recommendations regarding serum calcium levels in patients with chronic kidney disease from the following groups were discussed: Kidney Disease Outcomes Quality Initiative, British Renal Association, Canadian Society of Nephrology, European Best Practice Guidelines, and International Guidelines.
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Major Recommendations
Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
No recommendations possible based on Level I or II evidence
Suggestions for Clinical Care
(Suggestions are based on Level III and IV evidence)
- In Stage 5 kidney disease, predialysis albumin-corrected serum calcium should be kept within the normal laboratory reference range, preferably towards the lower end (2.1 to 2.4 mmol/L) provided that keeping serum calcium at this level does not worsen hyperparathyroidism. (Opinion)
- In Stage 3 and 4 kidney disease, serum calcium should be kept within the normal laboratory reference range. (Opinion)
- A predialysis blood sample should be used. (Level III evidence)
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test
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Evidence Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").
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Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
Appropriate management of serum calcium levels in patients with chronic kidney disease
Potential Harms
Keeping serum calcium at the lower end (2.1 to 2.4 mmol/L) of normal may worsen hyperparathyroidism.
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Implementation of the Guideline
Description of Implementation Strategy
An implementation strategy was not provided.
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Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Living with Illness
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Identifying Information and Availability
Bibliographic Source(s)
| Hawley C, Elder G. Calcium. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Oct. 7 p. [14 references] |
| Hawley C. Calcium. Nephrology 2006 Apr;11(S1):S198-200. |
Adaptation
Not applicable: The guideline was not adapted from another source.
Guideline Developer(s)
Caring for Australasians with Renal Impairment - Disease Specific Society
Source(s) of Funding
Industry-sponsored funding administered through Kidney Health Australia
Composition of Group That Authored the Guideline
Authors: Carmel Hawley and Grahame Elder
Financial Disclosures/Conflicts of Interest
All guideline writers are required to fill out a declaration of conflict of interest.
Guideline Status
This is the current release of the guideline.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the Caring for Australasians with Renal Impairment Web site  .
Print copies: Available from Caring for Australasians with Renal Impairment, Locked Bag 4001, Centre for Kidney Research, Westmead NSW, Australia 2145
Availability of Companion Documents
NGC Status
This NGC summary was completed by ECRI Institute on June 5, 2008. The information was verified by the guideline developer on June 11, 2008.
Copyright Statement
This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.
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